The present invention relates generally to rehabilitation therapy devices and methods. More specifically, the present invention relates to devices and methods utilizing body sensors coupled to computers to drive computer games and record body movements for rehabilitation therapy analysis. In particular, the present invention requires purposeful effort toward movement or actual body movement to play computer games in order to encourage performance of otherwise dull and repetitive rehabilitation therapy movements.
Each year thousands of individuals face the need to perform some type of rehabilitation therapy program such as physical therapy or occupational therapy. Health care professionals and consumers generally recognize that such rehabilitation therapy will significantly reduce the consequences of illness and injury, as well as promote health and increase the likelihood of greater and speedier recovery. Rehabilitation therapy is used by patients who have experienced impairments, disabilities, or handicaps. Rehabilitation therapy is also used to counter the effects of aging.
Traditionally, rehabilitation therapy for a patient involves diagnosing the impairment, disability, or handicap, evaluating the individual""s capabilities and ambitions, establishing a rehabilitation program directed toward those goals, and performing the rehabilitation program. Two major tasks of successful rehabilitation therapy are overcoming the individual""s lack of motivation and evaluating the individual""s progress in the rehabilitation program.
For many people, rehabilitation programs last several weeks, months, and even years. Improvement is often so small and slow that it may not be perceived by either the individual or by the rehabilitation team members. The length of time required and the inconsequential, incremental pace of improvement cause many patients to lose motivation for participation in the rehabilitation program. Patients become discouraged when they cannot feel or see improvements in their capabilities. Members of the rehabilitation therapy team often spend a large amount of time working to increase the motivation of individuals to continue working on the rehabilitation program. The end result is less effective and less efficient rehabilitation.
During rehabilitation, patients are taught how to move correctly and are given exercises to diminish their movement impairments. To correctly learn movements and exercises, patients often require many repetitions of instructions from the therapists. However, the repetition of exercises by a patient under continuous supervision of a therapist is prohibitively costly. Therefore, patients must cooperate in their rehabilitation by practicing the movements and performing the exercises independently. A direct relationship between patient compliance with therapy and decreasing movement impairment has been demonstrated. Lack of motivation to continue with practice is detrimental to progress in a rehabilitation program. Successful rehabilitation depends not only on the patient""s repetition of exercises and movements, but also requires that the exercises and movements be performed correctly.
Biofeedback is a treatment technique used with patients who have a loss of perception of some body function. Biofeedback monitors the body function for which the patient has lost perception and provides patients with some type of visual or auditory signal as evidence of a change in that body function. Biofeedback is used in rehabilitation therapy to provide patients with information as to when they have performed the exercise correctly.
Electromyographic (EMG) biofeedback has been successfully used during rehabilitation to help patients activate muscles and to re-educate patients in the use of their muscles. Patients have experienced marked improvement in muscle function following use of EMG biofeedback. Currently marketed EMG feedback systems provide minimal information to either the clinician or patient. The feedback often consists of either visual light blips or auditory signals or both. The majority of EMG biofeedback devices consist of a bank of light-emitting diodes and an auditory tone that responds to the muscular effort of a patient. The stronger the muscular effort by the patient, the greater the amount of EMG detected and the greater the number of LEDs illuminated and the greater the auditory tone. Thus, patients are xe2x80x9crewardedxe2x80x9d for their muscular effort with lights and tones. A few EMG feedback systems have a computer interface that displays the EMG signal in a graphic representation. Other EMG devices have been developed which ask a patient to attempt to reproduce a muscular effort that rises and falls according to a preset pattern. At present, no rehabilitation device (biofeedback or EMG) exists which provides a variety of novel and motivating experiences. Evaluation of progress in a rehabilitation therapy program is problematic in part because of the small increments in the improvement of individuals. Currently used rehabilitation evaluation instruments and methods often require substantial change in the function of the individual being tested in order to register a change in the score. Often the rehabilitation evaluation instruments and methods are too crude to detect the small incremental changes observed by the rehabilitation clinicians. To meet the need for evaluating the small change in patients, rehabilitation clinicians often record the number of repetitions, laps, bends, lifts, and other movements performed as a way of implying a change in strength, flexibility, coordination, or functional activities. This method of evaluation has been shown to have poor correlation with patient function in that patients often perform more movements but still having poor function.
Information from EMG biofeedback devices regarding overall patient performance during a treatment session is extremely limited. Current feedback systems do not provide data for the clinical therapists that can be easily used to evaluate the precision of subject movements or exercises. Using traditional biofeedback during a therapy session, a therapist would only be able to grossly estimate the frequency of patient attempts or successes of a movement or exercise with little or no data provided by the EMG equipment.
Another problem encountered during the evaluation of progress in a rehabilitation therapy program is that the motivation of an individual in performing the testing will effect the outcome of the testing. In order to achieve valid and reliable measurements, individuals must actively participate in the testing. To best identify the maximum outcome from rehabilitation therapy, the subject must participate with maximum effort. Lack of motivation to participate with maximum effort can greatly skew the results of the evaluation tests.
A biofeedback device that can provide an individual with an attractive and motivating feedback would be beneficial in creating an inducement for rehabilitation patients to continue with their exercises. A device that could provide appropriate feedback to the patient about the success of an effort would be valuable and could promote independent practice of movements and exercises. A device that elicited maximum patient effort in evaluation tests would be beneficial.
A system for rehabilitative therapy such as physical and occupational therapy including body sensors coupled to a computer which is running a software program that uses muscular effort or body movement to control gamepiece or cursor movement of a computer game. The software system records the muscular effort or body movements for later retrieval and analysis. Muscular effort can include contraction of a muscle or force generated from the contraction of a muscle, and body movements can include any joint motion (flexion, extension, abduction, adduction or any rotation).
The software programming aspect of the present invention can unite and control other components of the system. The central or controlling software can coordinate and control other software programs and functions. The central program can switch between functions according to the user selection on a graphic user interface (GUI). The central program can use a program written in languages such as one of the Microsoft family of programs (Visual Basic, Visual C etc.) or C++ or Java or other programming systems. In some embodiments, some software component programs of the central software utilize a freeware programming environment software package, xe2x80x9cNeatToolsxe2x80x9d, available over the Internet. NeatTools allows construction of simple drivers by visually connecting blocks on a display screen.
In one embodiment, the user will put information regarding the subject into the computer. From a GUI selection screen, the user can be queried for information about the subject and the treatment to be performed. Patient information can include patient identifiers, age, injury, and rehabilitation goals or impairments being treated. All data from the subject information section is transferred to a permanent memory location on the computer such as a hard or floppy drive device. New subject information is automatically recorded into a relational database so that information need only be entered at one time. In subsequent treatment sessions, the user will be able to select either an existing subject or to set up for a new subject.
One embodiment of the software system application uses a GUI to lead the user through setting up the system for use with a subject. The GUI leads the user through selecting the type of sensors used and the location of the sensors on the body of the subject. Data obtained from the set up software system can be saved in a permanent memory location on the computer such as a hard or floppy drive device.
Another embodiment of the software applications is the calibration or limit determination. The software program can process the signal from the sensors to establish upper and lower limits of signal corresponding to limits from the person on whom the sensor is located. The upper and lower limits of the signal from the sensor can be converted to represent a scale from 1 to 100% of the range of the signal present as the person performs a muscle contraction or movement.
Yet another aspect of the computer software applications is a zeroing function. This software functions to shift the signal so that the 0% limit of the signal is displayed at one extreme of the signal display window and the 100% limit of the signal is displayed at the other extreme of the signal display window. The zeroing function of the software application allows the rehabilitation therapist optimized viewing of the signal.
Yet another aspect of the present invention includes the setting of a threshold level. This software functions to identify the level at which the signal is considered to have achieved a level sufficient to control another set of circuitry. Once the scale is established, a threshold can be set by the user to require a given amount of effort from the person on whom the sensor is located. With the scaling and threshold functions the software can be adjusted to meet any functional goals for the patients as required by the rehabilitation therapists. The rehabilitation therapist can adjust a slider bar or other GUI on the computer screen to select the level at which a signal must exceed in order for the subject to receive feedback from the application software.
Another aspect of the computer program applications includes an algorithm to control the speed of the cursor or gamepiece. The rehabilitation therapist can adjust a slider bar or other GUI on the computer screen to create a faster or slower cursor movement. The speed adjust will affect the mouse movement speed, the gamepiece movement, or the speed of any external devices controlled by the software.
Another embodiment of the computer program application includes the launching of games from within the game rather than through the desktop or any other system. The games are both launched and reset by code within the central computer software application.
Yet another aspect of the computer software application includes an automated data acquisition of the signal during the entire time the software application is active. Parameters from each channel of sensor signal can be automatically acquired and saved into a permanent memory location such as a data file on a hard or floppy drive location.
Still another embodiment of the computer software application includes an automated motor control assessment. The automated motor control assessment software uses the input signal to control the cursor for interactive targeting and tracking games. During the games, all aspects of the target can be controlled and recorded by the software. The software uses the signal from the sensors to control the game cursor. The automated motor control assessment software can record the time required for the subject to move the cursor onto the target and record the values and store them into the data file. The software applications can also calculate the error between the position of the target and the position of the cursor and record the values and store them into the datafile. The automated motor control assessment software application can be launched by the central software application.
One embodiment of the system utilizes body sensors such as goniometers, torsiometers, bend sensors, tilt sensors, pressure sensors, force sensors, accelerometers, and EMG devices to detect muscle contraction and/or body position and/or body movement. Used in conjunction with the computer software applications, the devices can support multiple measurements and have multiple channels simultaneously active within a single device, such as one channel for measuring bend and the other for measuring rotation. The sensors are preferably coupled to an interface, either integral with the sensor or outside the sensor in an interface box. One type of interface box includes a microprocessor such as the PIC family of microprocessors, which draws little current and can be easily programmed. The interface device can accept the sensor output signal and condition and digitize the signal before it is sent to a computer input port. Control of the entire system of sensors and game piece, mouse or external device movement and automated acquisition of information from the sensors, is accomplished by software which runs within the computer to which everything is connected via the interface device.
In preferred embodiments of the invention, a signal is sent from a sensor or interface device to a computer port such as a serial port, mouse port, game port, infrared port, USB port, or parallel port. In the preferred embodiments, the data signal is retrieved through software that receives the data from internal locations corresponding to inputs from the various computer ports. The preferred embodiment software then processes the data from the inputs and uses the signal to control various components of the computer system. In one embodiment, data can be processed through the software and may be sent into a keyboard buffer that the computer interprets as arrow keys being depressed. In another embodiment, data from the sensors is processed through the software and may be interpreted by the computer as a movement of the mouse in one direction.
In some alternate embodiments of the invention, physical devices are used and physically coupled to a computer port to accomplish similar goals. One set of software applications according the present invention sends data from the input interface box to control the mouse on the computer. Another set of software sends data from the input interface box to control the joystick or gameport on the computer. Yet another set of software sends keystrokes such arrow keys to the keyboard port of a computer. Still another embodiment of this device uses the software to send data from the input interface device to one of the ports of the computer (such as the parallel, USB or serial ports) which in turn sends the signal to a controller for an external game unit such as the Sega or Nintendo System. Another embodiment of this device uses the software to send data from the input interface device to one of the ports of the computer (such as the parallel, USB or serial ports) which in turn sends the signal back out through one of the ports of the computer (such as the parallel, USB or serial ports) and into a controller for an external physical device like a remote controlled car. The software programs process the signal from the sensors for use with many cursor or gamepiece movements. In one software application, the relative position of the cursor or gamepiece corresponds to the relative position of the signal within the scale. For example, if the horizontal axis of a computer screen is considered to range from 0% on the left edge to 100% on the right edge, the position of the cursor could be represented as a percentage of the horizontal axis. The percentage of the signal within the scale would directly translate to the location of the cursor as a percentage of the horizontal axis.
In another software application, a change in the location of the cursor or gamepiece corresponds to the signal exceeding the threshold that was set by the rehabilitation therapist. For example, if the signal ranges from 0% to 100% and the threshold is set to 70%, and the signal is set to control the horizontal movement of the cursor or gamepiece to the right, any time the signal exceeds the threshold, the cursor or gamepiece will move to the right. A separate signal would be needed to control the movement of the cursor to the left along the horizontal axis.
A data acquisition module will record data into a file. A patient or therapist can enter patient information into the computer. Patient information can include patient identifiers, age, injury, and rehabilitation goals or impairments being treated. The muscle or body sensor or sensors can be secured to the patient and the sensors connected to a converter or interface which is in turn connected to an input port of the computer. After any required initialization or calibration of the sensors, the tracking or monitoring software can be started to monitor the data generated by the muscle and body sensors. The game software can be started and the patient can play a game, moving the cursor or gamepiece by contracting a muscle or moving a body part. In one embodiment, left-to-right cursor or paddle movement in a game such as Breakout or Pong is performed by body movements such as flexing and extending a joint. In another embodiment, left to right gamepiece movement is accomplished using body movements such as joint flexing and extending, while up and down gamepiece movement is accomplished using body movements such as joint rotations in opposite directions. By using two sensor inputs, full screen control of cursor position can be accomplished, enabling play of a game requiring two-dimensional gamepiece movement such as Pac Man.
After play is finished, the core software application can close the file into which the muscle contraction or body sensor data has been deposited. Analysis and summary of the muscle contraction or body sensor data can be carried out and the results displayed and dumped into a file for later review. In one embodiment, the summary is uploaded to another computer for storage and review by a therapist or medical care provider. In another embodiment, the summary data from each session is printed in a format that can be included in the chart of a patient. In one embodiment, the summary data from each session can be plotted over several sessions, such as over several days, weeks, and months. In one embodiment, the data is plotted over time to give the patient a sense of the progress being made.